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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390319950
Report Date: 01/28/2020
Date Signed: 01/28/2020 03:30:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MONTEZUMA SCHOOLFACILITY NUMBER:
390319950
ADMINISTRATOR:KELLER, DEBRAFACILITY TYPE:
850
ADDRESS:2843 FARMINGTONTELEPHONE:
(209) 933-7255
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:48CENSUS: 19DATE:
01/28/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Gabriela FloresTIME COMPLETED:
03:40 PM
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LPA Baney met with Gabriela Flores to conduct an annual inspection. LPA toured the inside and outside of the facility, including all activity/classroom areas, restrooms and outdoor play areas. LPA reviewed health related services, including first aid supplies, furniture, equipment, drinking water and food service provisions.
LPA observed two toilets and two sinks for use by the children in the Head Start portable. LPA observed a separate staff bathroom which was inaccessible to the children. Cleaning supplies were stored in an upper locked cabinet. LPA observed children's toys were in good condition and in sufficient supply.

The Head Start program in the portable is Monday - Friday, from 8:00am to 2:00pm they serve breakfast and lunch children.. The State Preschool located in room 4 serves breakfast to morning class and lunch to afternoon class.

LPA observed that all of the required forms were posted including a license, meal/snack menu that meets regulation, parents' rights' poster, emergency care and disaster plan and seat belt law.
LPA reviewed the sign/in-sign/out sheet, children's and personnel records. All staff present during today's inspection have a fingerprint clearance through the Stockton Unified School District. LPA observed that health screening reports and proof of immunization are centrally stored in an off site location. At least one staff member present during today's inspection has current Pediatric CPR and First Aid. LPA observed training certificate for approved third party mandated reporter training resource for all staff.

Website was provided (www.ccld.ca.gov), so that staff may obtain updated licensing information, regulations, and forms.

LPA did not observe any Title 22 Regulation deficiencies. Notice of Site Visit Posted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte BaneyTELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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